Kwack E K, Kim D J, Park T I, Cho K R, Kwon I H, Sohn Y K
Department of Pathology, Kyungpook National University School of Medicine, Taegu, Korea.
J Korean Med Sci. 1999 Dec;14(6):688-92. doi: 10.3346/jkms.1999.14.6.688.
Described here is a case of accidental intrathecal administration of vincristine with pathologic findings in the central nervous system. A 3-year-old boy with acute lymphoblastic leukemia, was given his ninth course chemotherapy. Vincristine was accidentally injected intrathecally. The clinical course was rapidly progressive (6-day course) and resulted in death. An autopsy was done. The brain and spinal cord was grossly edematous and congested without any specific feature. Histologically, profound loss of neuron was noted in the spinal cord. Remaining neurons in the spinal cord, particularly anterior horn cells were markedly swollen. The spinal nerves show diffuse axonal degeneration and myelin loss. The upstream portion of the spinal cord (brain stem, cerebellum, cerebrum) showed patchy loss of neurons, especially Purkinje cells and granular cells of the cerebellar cortex. Many neurons showed axonal reaction (chromatolysis) with swelling. Several neurons show intracytoplasmic eosinophilic inclusion body. Myelin loss, axonal swelling and enlargement of perivascular spaces were seen throughout the white matter of central nervous system.
本文描述了一例鞘内误注长春新碱并伴有中枢神经系统病理表现的病例。一名3岁急性淋巴细胞白血病男孩接受第九疗程化疗时，长春新碱被误注入鞘内。临床病程进展迅速（6天病程），最终导致死亡。进行了尸检。脑和脊髓肉眼可见严重水肿和充血，无任何特异性特征。组织学检查发现脊髓神经元严重缺失。脊髓中剩余的神经元，特别是前角细胞明显肿胀。脊神经显示弥漫性轴索变性和髓鞘脱失。脊髓上游部分（脑干、小脑、大脑）显示神经元散在缺失，尤其是小脑皮质的浦肯野细胞和颗粒细胞。许多神经元出现轴突反应（染色质溶解）并肿胀。一些神经元显示胞浆内嗜酸性包涵体。中枢神经系统白质各处均可见髓鞘脱失、轴突肿胀和血管周围间隙增宽。
